Our Editor in the Field

The Royal Osteoporosis Society

This month, we asked the experts at the Royal Osteoporosis Society to brief us on what we need to know about bones. Here’s what we learned:

Every minute of every day, someone somewhere suffers a bone fracture, due to osteoporosis. Yet, because of under-diagnosis, under-treatment, and low public awareness, it is still often referred to as ‘the silent disease’. Common misconceptions persist— that shrinking bodies are just a normal part of getting older, that osteoporosis only affects women, that bones are lifeless and unchangeable. None of this is true. In fact, we all can and should take positive steps to build our bone strength and prevent osteoporosis and broken bones. Bone health affects everyone and it can be acted upon at any age. The Royal Osteoporosis Society is working to turn up the volume on bone health and highlight that it’s never too early to start looking after your bones.

There are 206 bones in the human body. Our skeleton works to support the body, protect our vital organs, help the body move, and make blood cells.

Bone tissue is alive and constantly changes throughout our lives, to ensure it remains as healthy as possible. Every day, older, worn-out bone tissue is broken down by specialist cells called osteoclasts and rebuilt by cells called osteoblasts. This process of renewal is known as ‘bone remodelling’, or ‘bone turnover’. As we grow, osteoblasts work faster. This allows the skeleton to increase in size, density, and strength. During this period of rapid bone growth, it takes the skeleton just two years to completely renew itself. In adults, this same process takes seven to ten years.

Bones stop growing in length between the ages of sixteen and eighteen. But the total amount of bone tissue you have— your bone density —continues to increase slowly, until your late twenties. Up until about the age of thirty-five, there is usually a balance between the amount of bone that is removed, and the amount of bone that is laid down. The total amount of bone tissue stays the same. From our late thirties onward, however, the amount of bone that is removed and the amount of bone that is laid down starts to get slightly out of balance. This happens at different rates in different people. More bone tissue is removed, and the total amount of bone tissue starts to decrease. During this process, your bones don't look any different from the outside. But inside, the outside shell of the bone thins. And the struts that make up the structure inside your bones become thinner and sometimes break down. The older you get, the more bone tissue you lose. This is why osteoporosis and broken bones become more likely with age.

Your genes can determine the potential size and strength of your skeleton. Research shows that if one of your parents broke their hip, you are more likely to break a bone yourself. And if you've broken bones easily in the past, you are much more likely to break a bone in the future. Research also shows that after one broken bone you are two to three times more likely to have another in the future. Your gender is also relevant. Osteoporosis and broken bones are more common in women than men; over the age of fifty, half of women, but only one in five men will break a bone because of osteoporosis. There are several reasons for this. Having bigger bones reduces the risk of them breaking, and women tend to have smaller bones than men. Bones lose strength at a faster rate after the menopause because levels of oestrogen— the female sex hormone that helps keep bones strong —decrease. But women also tend to live longer, on average, so are more likely to live with the lower bone strength that comes with age.

Your lifestyle choices can have a big impact on your bone health, too. We can pay into our bone bank and reduce the risk of osteoporosis by doing regular weight-bearing and muscle-strengthening exercise, eating a healthy balanced diet with adequate calcium, and ensuring we have sufficient Vitamin D.

You are weight-bearing when you are standing, with the weight of your whole body pulling down on your skeleton. Weight-bearing exercise with impact involves being on your feet and adding an additional force or jolt through your skeleton. This could be anything from walking to star jumps. If you have low balance, co-ordination, and reflexes, you are more likely to trip or stumble, and potentially break a bone in a fall, so exercise that improves balance, such as Pilates or yoga, is also helpful. When your muscles pull on your bones it gives your bones work to do. Your bones respond by renewing themselves and maintaining or improving their strength. As your muscles get stronger, they pull harder, meaning your bones are more likely to become stronger. If you have low body weight, you're more likely to have less bone tissue. If you're older, having low body weight also means you have less fat padding around the hips to cushion the impact of a fall, making broken bones even more likely.

Smoking slows down the cells that build bone in your body. If you're a woman, smoking also increases your chances of an earlier menopause. Postmenopausal women have an increased risk of osteoporosis and breaking a bone. Similarly, drinking too much alcohol affects the cells that build and break down bone. It also makes you unsteady on your feet, making you more likely to trip, fall and break a bone.

Royal Osteoporosis Society

Your bones are alive, so a healthy diet is important in maintaining their health. Make sure you are getting enough calcium and vitamins from your nutrition sources. For vegans, this can mean ensuring meat and dairy replacements, such as tofu or oat milk, are fortified with calcium. Good sources of calcium include green leafy vegetables, almonds, sesame seed spread, dried fruit, pulses, fortified soya and nut drinks and some types of soya protein (tofu processed with calcium). You can also get protein from pulses— like lentils and chickpeas —nuts, tofu (soya bean curd) and spreads, like peanut butter. Adults need 700mg of calcium a day, so be aware that you need quite large portions of some foods— such as dark green leaved vegetables, pulses, or cereals —to get the protein and calcium your bones need. Some people may wish to consider taking vitamin supplements.

Make sure you get enough Vitamin D. This can be through exposure to the sun during the summer months, when the sun’s rays stimulate the skin to produce Vitamin D. About ten minutes’ exposure to bare face and arms, twice a day, is sensible and sufficient. Be sure not to get burned. Alternatively, you can take 10 micrograms of a daily supplement. In the UK, everyone should consider taking a supplement from the end of September to the end of March, anyway, because you can’t get enough Vitamin D from the sun’s rays during that time. Vitamin D3 supplements are slightly more effective at raising Vitamin D levels, but if you’re vegan, choose a supplement that contains Vitamin D2 (ergocalciferol) as this comes from a plant source rather than D3 (cholecalciferol) which comes from sheep’s wool.

Royal Osteoporosis Society

Osteoporosis currently affects 3.5 million in the UK. But the silence around the condition, the missed opportunities for diagnosis and the postcode lottery for quality treatment mean that 90,000 people every year in the UK are missing out on the medication they need to protect their bones. Allopathic medications for osteoporosis are either ‘antiresorptive’, acting to slow down the osteoclasts in breaking down bone tissue, or ‘anabolic’, stimulating the osteoblasts to build new bone, or a combination of both. Regardless of their action, osteoporosis treatments reduce the risk of fragile bones breaking, but don't reduce the pain of broken bones. In conclusion, here are our five top tips for maintaining healthy bones:

 Aim for a well-balanced, mixed diet with plenty of protein and calcium.

 Make sure you get enough Vitamin D.

 Maintain a healthy body weight— neither under nor overweight.

 Take weight-bearing, as well as muscle-strengthening exercise.

 Don’t smoke or consume alcohol above the recommended limits.

We are very grateful to the Royal Osteoporosis Society for their expertise and generous support. You can find out more on their very informative website: www.theros.org.uk, where you’ll also find a donation button to support their important work.